This site exists to generate discussion and collate opinions on the experience of using the NHS ePortfolio. It exists to persuade those in charge that a re-imagining of the ePortfolio is needed. You matter, your training matters, and whether you're a trainee or an educator, your time is too valuable to waste ticking boxes. An ePortfolio could be a beautiful thing. Make it happen.

There’s a lot to say on this subject so please follow the links to learn more. I have tried to summarise some of the key opportunities and challenges and how they relate specifically to doctor’s ePortfolios and Postgraduate Training. This is not because Open Badges are limited to this context, but because this blog is focused on these issues. Overall my personal opinions are:

there is a need for a better method to collate and accredit learning, particularly informal learning. CVs are limiting

this is not a threat to established models of accreditation, or to institutions, but a complimentary system

Open badges have great potential as a mechanism of celebrating excellence and supporting medical trainees in differentiating themselves

as with all technology/software we need to be clear about what it can and can’t do, and not expect a panacea

as doctors we are currently limited by the fact that existing systems do not interface with other systems. No API = no possibility for progress. The whole point is that open badges cut across multiple systems and contexts, so they must not exist in yet another silo, separate from eg the ePortfolio. We need progress in this urgently

the drive for these new ideas and opportunities will come from the community, not institutions. Most institutions are likely to be sceptical initially but catch on later once the principle is established (examples would include Hospital Trusts, Royal Colleges, LETBs, Universities…). I would love to be proved wrong about this!

The Concept

Open badges are a mechanism for accrediting learning that happens everywhere. They are more than a graphic that you slap onto your online profile. The image has inbuilt into its’ code some essential data:

This is important as this means they can’t be simply copied or faked, and there is a way to probe what the badge means by checking the criteria and evidence. Much more information is on the Mozilla wiki, site, and collated blogs.

Future developments such as the ability to encode verification and endorsement mechanisms will be essential to win over the evidence-focused and reputation-aware landscape of healthcare education.

Opportunities for Postgraduate Training

Learning does not just happen in lecture theatres. We know this and demonstrate it every day. As medical students and doctors we piece together our education and training from a diverse range of informal and formal providers and contexts.

Last week I had many learning opportunities: I sat in on a specialist clinic, attended a Radiology meeting, completed an e-learning module, read several articles through UptoDate and pubmed searches, read a blog, contributed to debates on Twitter and followed links from tweets to journal papers, went to a seminar, and had a case discussion with a senior colleague. Trying to log all of this in existing tools is a challenge. My clinical NHS ePortfolio is certainly not flexible enough to facilitate this, and is unlikely to ever be, since it’s structure is dictated by committees of people who don’t use it. But the core system doesn’t have to fulfil every need if it interfaces with other systems. Open Badges could fit into this model very well.

Things that could be badged in medical education (a small and not at all exhaustive list):

contribution to #twitjc as a one off (1 badge), on a regular basis (higher badge), as host (super-badge)

completion of an online e-learning module (1 badge), completion of 15 modules relevant to your training programme (build up to unlock higher badge – BMJ already follow this principle with Silver/Platinum user. Wouldn’t it be great to draw other providers together along similar principles?)

giving a peer-led teaching session (1 badge), running a teaching programme as a result of an identified need (higher badge), having an impact ie safer handover/fewer bacteraemias/better compliance with antibiotic policy (super-badge)

completing generic mandatory training modules – many of which have been moved online (eg hand-washing, manual handling, equality and diversity), which could then be transported to a new Trust. A junior doctor could show their badges and not have to repeat generic training when they move jobs at 4 months, and instead spend time doing locally-specific training and then meeting the team (this was discussed at the workshop – great idea that I do not take credit for!)

Challenges

Many of these are discussed in more detail on the Mozilla pages (with additional technical, pedagogical, conceptual and philosophical considerations).

Equivalence: is my equality and diversity training module at St Elsewhere NHS Trust equivalent to your E&D module at St Somewhere Else? And will you accept is as such? Who decides?

Fake-ability: someone could set themselves up as a fake version of Highly Prestigious University and issue badges in their name. Future developments of verification (eg verified accounts) and endorsement would help with this

Over-exposure: If you can badge anything, does this devalue them as a currency? Not necessarily. There will be hierarchies of badge, just like there are hierarchies and power structures in other spheres. A peer-issued badge for ‘general awesomeness‘ would be value-less for a job application and no badge earner would choose to display this badge in that context. In contrast a University issued badge for ‘significant contribution to bedside Undergraduate Teaching’ or a Trust issued badge for ‘leadership in quality improvement’ would be worth significantly more.

Validity: What if someone earned a badge for hand-washing, but couldn’t then demonstrate the skill? Theory does not necessarily transfer to practice, but this is not a problem of open badges themselves, but of all teaching and learning

Admin support: the creation and issuing of badges needs thought and planning. It does not have to mean lots of additional work but of course would require initial startup resources. The discussion of beenfits vs costs needs to be fleshed out, and systems worked out to make badge issuing something people feel supported in doing, and will seek to do. The guys from myknowledgemap and reallymanagingassessment tools have thought about this already, and done a lot of the work. They have envisaged ways to support less code-literate mortals (like me) in the process. We can learn from their expertise, share the work, share costs, share, share, share….

What’s inspiring about the Mozilla Open Badges project is the level of transparency and collaboration. The Mozilla Foundation is a global non-profit whose only motive is to “promote openness, innovation and participation in the internet”. This open-ness is incredibly powerful. They share all their code and processes, which allows others to create widgets and plug-ins and build layers of code/systems on top of their core system. This does not challenge or threaten Mozilla. It enhances their product and makes it more attractive and useful. This is a general lesson we can learn and apply to other contexts. The most obvious example would be NHS Hackday. Imagine what we could do with an NHS ePortfolio API (for a start we could already have built an app)! Imagine if Open Badges interfaced with the NHS ePortfolio! That would be one way to gather all the informal (and formal) lifelong-learning that is already taking place, and strongly encouraged by Royal Colleges, the GMC, and other healthcare bodies – from medical school entry to retirement.

I think an important point is that Open Badges are not a gimic. They are not a niche internet project. They are a response to a much bigger challenge to traditional learning. You may not think they are the right response, but they should be seen in this context. There has been a shift in how and where learning occurs which is challenging but positive. Better informed, engaged and motivated clinicians provide better patient care: what we’re all here for in the end. We need systems that facilitate and celebrate learning in new contexts. As learners we yearn for it it. As institutions we have a duty to support it. As patients we should welcome it. Open Badges could be such a system.

Thanks to Leeds School of Medicine for being so open and welcoming; to myknowledgemap for being so positive about collaborating; to Tim from NES for putting up with my ranting; and to Doug from Mozilla for his pragmatism, enthusiasm and expert workshop facilitation.

Things have been a little quiet on the site lately, and you would be forgiven for wondering whether I have lost interest in the NHS ePortfolio. You may have started to think that nothing is being achieved, and therefore not bothered to comment or contribute to the discussion.

Don’t believe it!

Progress may be slow, but real change takes time. Quick fixes are great and can have a major impact on functionality. Remember the problems with being unable to link to multiple curriculum items? Fixed! See the tech improvement shopping list for other modifications that have already happened. Quick fixes are also visible and keep up enthusiasm and morale. But they don’t address the route causes of problems and don’t change systems. Changing systems takes time.

A major breakthrough has been the creation of an ePortfolio reference group at the Royal College of Physicians. You can apply to be a member of this panel and get your voice heard directly by the College. Not a member of the RCP? Then ask your own College if they have a user group you can join. And if they don’t have one, ask why not. The systems imposed on trainees are currently not fit for purpose, and we need to make sure people in charge understand this.

Dont forget that NES, the group who run the NHS ePortfolio used by Physicians, Paediatricians and others, is holding feedback events. I’m sure that this is in no small part due to pressure from this site and discussions on Twitter. If you can, go along and make your voice heard.

People are listening. I have meetings coming up with the Royal College of GPs who use a different ePortfolio system but share common needs. I am also having a follow-up meeting at the Royal College of Physicians. We must clarify the commissioning and costs of the ePortfolio in order to collaborate across Colleges and effect change. When money is scarce we need to make it go further. The Academy of Medical Royal Colleges Trainee Doctor Group are gathering data on the systems in use by all specialities which will be essential is informing this discussion.